JAI PARKASH MUKAND LAL INNOVATIVE

ENGINEERING & TECHNOLOGY INSTITUTE

VILLAGE CHHOTABANS, RADAUR,
DISTRICT YAMUNA NAGAR (HARYANA) 135133.
1.

Post Applied for ....Subject.

2.

Name in full ..
(a)

Date of Birth..

(b)

Place of Birth .

(c)

NationalitySex....

(d)

Blood Group (e) Identification Marks ..

(f)

PAN No. Driving License NoPassport No.

PHOTOGRAPH

Candidate please enclose I .D. Proof: (Ration Card /Voter Card/Driving

License/PAN card/Passport)
3.

Present Postal Address ( in block letters) .

...
..Pin Code...
PhoneMobile No...E-mail, if any..

4.

Permanent Home Address (in block letters)..

...
..Pin Code...
PhoneMobile No...E-mail, if any...

5.

(a) Fathers Name Mothers Name.

(b) Name of Husband/wife (if married)
(c) Details of Family

6.

Whether belongs to GEN/SC/ST/BC/OBC/PH..

7.

a) Present designation & name of employer (if employed)...

...
b) Grade and consolidated salary ....

8.

Have you ever been prosecuted, kept under detention or bound down, fined, convicted by
a Court of Law for any offence or debarred/disqualified by any University, Public Service
Commission from appearing at its examinations/selection? Is any case pending against
you in any Court of law at the time of filling up of this application form? If the answer is
Yes full particulars of the case, detention, fine conviction, sentence etc. should be
given.

9.

Educational Qualification (from Matriculation onwards):

Sr.
No.

Exam. Passed

1.

Matric

2.

Hr.Sec/ Pre-Univ.

3.

5.

B.A./B.Sc./
B.Com./ B.Tech.
M.A./M.Sc./M.C
om/.MBA/MCA/
M.Tech.
M.Phil

6.

Ph.D.

7.

Any other Exam.

4.

University/
Board

Name of the Institute

Year of % age of Regular/Cor

Passing Marks&
respondence
Division
/Part time

*Please attach photo copies of all certificates.

10.

Topic of M.Phil Dissertation..

11.

Experience:

Employers Name & Address

From

Duration
To
Total
Period

Nature of
Duties

Emoluments
& Scale etc.

Reason
For
Leaving

Last employment

In case of Teaching Experience attach result of Classes/Courses taught by you.

Please specify clearly whether you have worked in any of the Mukand Lal Institutions in earlier years.

Total experience: Under Graduate Classes..Yrs.

Post graduate Classes Yrs.

12.A

Topic of research for Ph.D.

Field of Specialization ..

No. of Publications

Publication

A
Published

B
In Press

C
Accepted for
Publication

D
Communicated
for publication

E
In preparation
for publication

Book
Ind./Jointly
Papers
Ind./Jointly
Abstracts
Ind./Jointly
Patents
Ind./Jointly
Attach a list of publications is respect of each category mentioned above.
13.

Extra Curricular Activities (Sports, Social, Literary Activities, N.C.C./N.S.S.) etc.

Name of
Activity

14.

Level/Name of the Competition

Year

Position Achieved

Conference/Seminar organized by you: (Attach list)

Conference

Name of
Conference

Place

Date

Sponsored/Faculty

National
International

15.

Any other achievement you would like to mention:..

16

HAVE YOU EVER BEEN CONNECTED WITH ANY POLITICAL PARTY,

IF SO GIVE DETAILS.
DO YOU HAVE ANY CONTRACT/BOND : ____________________________
WITH YOUR PRESENT EMPLOYER?
If Yes, Give details
DO YOU CONSUME LIQUOR?

: Yes/No

ARE YOU USED TO GAMBLING

: Yes/No

DO YOU HAVE ANY RELATIVE WORKING IN SETH JAI PARKASH MUKAND

LAL INSTITUTIONS OF KNOWLEDGE & SERVICE OR ANY RELATION WITH
ANY MEMBER OF THE MANAGING COMMITTEE
(If Yes, Furnish Details)
: Yes/No
PLEASE STATE WHETHER YOU ARE PURSUING ANY COURSE OF STUDIES AT
PRESENT ? IF YES, GIVE DETAILS:
.
Please note that:
(a)
You will not be allowed to undertake any further studies during your employment
without prior written permission of the competent authority.
(b)
You will not undertake any part-time job including coaching/tuition etc.
IF SELECTED, WHEN CAN YOU JOIN ?
:_____________________________
SALARY ACCEPTABLE
:_____________________________
NAME & ADDRESSES OF TWO REFERENCES, NOT RELATIVES:
____________________________
____________________________
____________________________
____________________________

_____________________________
_____________________________
_____________________________
_____________________________

I declare that the information given above is true and correct to the best of my knowledge and
belief & nothing has been concealed therein. I am aware that any false or incorrect information
by me may result in termination of my service with the institute. I have no objection, if you
enquire from any of my previous employers on any matter pertaining to me, if I join your
institute.

Place:____________
Date:_____________

(APPLICANTS SIGNATURE)